GAO

United States General Accounting Office

A

Testimony

Before the Subcommittee on Oversight and Investigations, 

Committee on Veterans’ Affairs, House of Representatives

For Release on Delivery

Expected at 2:00 p.m. EST

Wednesday, July 9, 2003

DEFENSE HEALTH CARE

Army Has Not Consistently 

Assessed the Health Status 

of Early-Deploying 

Reservists 

Statement of Marjorie E. Kanof

Director, Health Care—Clinical 

and Military Health Care Issues

GAO-03-997T
The Army has not consistently carried out the statutory requirements for 

monitoring the health and dental status of its early-deploying reservists. As a 

result, the Army does not have sufficient information to know how many 

reservists can perform their assigned duties and are ready for deployment. 

At reserve units GAO visited, approximately 66 percent of the medical 

records were available for review. At those locations, GAO found that about 

13 percent of the 5-year physical examinations had not been performed, 

about 49 percent of early-deploying reservists lacked current dental 

examinations, and none of the annual medical certificates required of 

reservists were completed by them and reviewed by the units. 

Medical experts recommend periodic physical and dental examinations as an 

effective means of assessing health. Army early-deploying reservists need to 

be healthy to meet the specific demands of their occupations; examinations 

and other health screenings can be used to identify those who cannot 

perform their assigned duties. Without adequate examinations, the Army 

may train, support, and mobilize reservists who are unfit for duty. 

DOD concurred with GAO’s recommendations to comply with statutory 

requirements to conduct medical and dental examinations and provide 

dental treatment. VA’s ability to perform its missions to provide medical 

care to veterans and compensate them for their service-connected 

disabilities could be hampered if the Army’s medical surveillance system 

contains inadequate or incomplete information. 

Site Visit Results for Seven U. S. Army Reserve Units 

13

68

100

49

0

20

40

60

80

100

Reservists

without a 

5-year physical 

Reservists

without a 

2-year physical

Reservists

without a selfcertification

Reservists

without a dental

examination

Percentage

Source:GAO analysis of Army data.

During the 1990-91 Persian Gulf 

War, health problems prevented 

the deployment of a significant 

number of Army reservists. As 

required by the National Defense 

Authorization Act for Fiscal Year 

2002, GAO reported on the Army’s 

efforts to assess the health status 

of its early-deploying reservists 

(Defense Health Care: Army 

Needs to Assess the Health Status 

of All Early-Deploying Reservists

[GAO-03-437, Apr. 15, 2003]). 

GAO was asked to testify on its 

findings on the Army’s health 

status assessments efforts and the 

implications of those assessments 

for the Department of Veterans 

Affairs (VA). Specifically, GAO 

was asked to determine if the Army 

is collecting and maintaining 

information on reservists’ health 

and review the value and 

advisability of providing 

examinations. For its report, GAO 

reviewed medical records at seven 

Army early-deploying reserve units 

to determine the number of 

required examinations that have 

been conducted and obtained 

expert opinion on the value of 

periodic examinations. 

www.gao.gov/cgi-bin/getrpt?GAO-03-997T.

To view the full testimony statement, including 

the scope and methodology, click on the link 

above. For more information, contact 

Marjorie E. Kanof at (202) 512-7101. 

Highlights of GAO-03-997T, a testimony 

before the Subcommittee on Oversight 

and Investigations, Committee on 

Veterans’ Affairs, House of 

Representatives 

July 9, 2003 

DEFENSE HEALTH CARE 

Army Has Not Consistently Assessed the 

Health Status of Early-Deploying 

Reservists 
Page 1 GAO-03-997T 

Mr. Chairman and Members of the Subcommittee: 

We are pleased to be here as you discuss health assessments for the men 

and women in the armed services. Both the Department of Defense 

(DOD) and the Department of Veterans Affairs (VA) need this information 

to perform their missions. DOD needs health status information to help 

ensure the deployment of healthy forces and the continued fitness of those 

forces. VA’s Veterans Benefits Administration (VBA) uses health 

information to adjudicate veterans’ claims for disability compensation 

related to service-connected injuries or illnesses. In addition, the Veterans 

Health Administration (VHA) needs this information to fulfill its mission to 

provide health care services to veterans. In this context, you asked us to 

discuss our recent report on the Department of the Army’s (Army) 

assessment of the health status of its reserve forces. The Army is 

increasingly relying on its 560,000 reservists to supplement the capabilities 

of our nation’s active duty forces for peacetime support operations as well 

as for war. 1

When reservists were mobilized during the 1990-91 Persian Gulf War, the 

Army discovered that due to medical reasons or poor dental status a 

significant number of them could not be deployed or had their deployment 

delayed.2

 In an effort to help ensure that Army reservists meet the 

military’s health standards and are ready to perform their assigned duties, 

the Congress augmented health assessment requirements that had been in 

place prior to the Persian Gulf War. Specifically, the Congress required 

the Army to monitor the health status of those designated as earlydeploying reservists3

 by providing annual medical screenings, annual 

dental screenings, selected dental treatment, and for those over age 40, 

physical examinations every 2 years. All reservists, including early 

deployers, are also required to disclose annually to the Army the status of 

 1

 The Army reserve components consist of the U.S. Army Reserve and the Army National 

Guard. The Army National Guard component carries out a dual mission. It is responsive to 

both the federal government for national security missions and to governors for state 

missions. 

2

 Mobilization is the process by which the armed forces are brought into a state of 

readiness for war or national emergency or to support some other operational mission. In 

this report, mobilization means calling up reserve components for active duty. Deployment 

involves the relocation of mobilized forces and materiel to desired areas of operation. 

3

 To support its mission needs and war plans, the Army has established Force Support 

Packages 1 and 2—a group of reservists who would normally be the first to be deployed in 

a ground conflict. We refer to these reservists as early-deploying reservists. 
Page 2 GAO-03-997T 

their physical and dental condition, and those under age 40 are required to 

undergo a physical examination once every 5 years. 

My testimony today is based on our April 2003 report on the Army’s efforts 

to assess the health status of the approximately 90,000 reservists who are 

specifically designated as early-deploying reservists.4

 We examined 

medical records to determine whether the Army is collecting and 

maintaining information on the health status of its early-deploying 

reservists. We also assessed the value of periodic physical and dental 

examinations and determined the advisability of the statutory 

requirements for the Army’s early-deploying reservists. 

To do our work, we visited seven early-deploying U.S. Army Reserve units 

in the states of Georgia, Maryland, and Texas and reviewed all available 

medical and dental records of reservists assigned to those units. Our 

analysis of the information gathered at these units is not projectable. We 

reviewed U.S. Army Reserve medical policies and regulations pertaining to 

early-deploying reservists. We also reviewed Army National Guard policies 

and procedures governing reservists’ health care but did not review 

medical or dental records at Army National Guard units. Additionally, we 

analyzed Army data showing the cost to perform periodic physical and 

dental examinations5

 and to provide dental treatment. We also reviewed 

studies and information on the effectiveness of periodic physical and 

dental examinations published by DOD, the Department of Health and 

Human Services (HHS), the National Institutes of Health, the American 

Medical Association, the Academy of General Dentistry, and others. We 

interviewed DOD officials in the offices of the Assistant Secretary of 

Defense for Reserve Affairs and the Assistant Secretary for Health Affairs, 

and officials in the Office of the Surgeon General, U.S. Army Forces 

Command and the Office of the Surgeon General, U.S. Army Reserve 

Command to obtain information on the health care provided to Army 

early-deploying reservists. We conducted our work from May 2002 through 

April 2003 in accordance with generally accepted government auditing 

standards. 

 4

 U.S. General Accounting Office, Defense Health Care: Army Needs to Assess the Health 

Status of All Early-Deploying Reservists, GAO-03-437 (Washington, D.C.: Apr. 15, 2003). 

5

 10 U.S.C. §1074a(d)(1)(C) requires the Army to provide early-deploying reservists with a 

dental screening. While a dental screening does not have to be performed by a dentist, the 

Army requires its early-deploying reservists to be examined by a dentist to fulfill the 

screening requirements. Therefore, in this report we use the term “examination” rather 

than “screening.” 
Page 3 GAO-03-997T 

In summary, the Army has not consistently carried out the statutory 

requirements for monitoring the health and dental status of Army earlydeploying reservists. As a result, the Army does not have sufficient 

information to know how many reservists can perform their assigned 

duties and are ready for deployment. At the seven units we visited, 

approximately 66 percent of the medical records were available for our 

review. Based on our review of available records, we found that about 13 

percent of the 5-year physical examinations had not been performed, and 

none of the annual medical certificates had been completed by reservists 

and reviewed by the units. Furthermore, 49 percent of early-deploying 

reservists lacked a current dental examination and 68 percent of those 

over the age of 40 lacked a current biennial physical examination. In 

addition, the Army does not have an automated system for maintaining 

accurate and complete medical information on early-deploying reservists. 

Periodic physical and dental examinations for early-deploying reservists 

are valuable for the Army because such examinations provide a means of 

determining reservists’ health status and ensuring the medical readiness of 

reserve forces. Without adequate examinations, the Army runs the risk of 

mobilizing early-deploying reservists who cannot be deployed because of 

their health. In the case of early-deploying reservists who cannot be 

deployed, the Army loses not only the amount it invested in salaries and 

training but also the particular skill or occupation it was relying on to fill a 

specific military need. In addition, for reservists who may become eligible 

for VA benefits, inadequate health information can make it more difficult 

to adjudicate claims for service-connected disabilities in an accurate and 

timely manner and to provide quality medical care. 

We made recommendations that the Army comply with existing statutory 

requirements to help ensure that early-deploying reservists are healthy to 

carry out their duties. DOD agreed with our recommendations. 

In recent years, reservists have regularly been called on to augment the 

capabilities of the active-duty forces. The Army is increasingly relying on 

its reserve forces to provide assistance with military conflicts and 

peacekeeping missions. As of April 2003, approximately 148,000 reservists6

from the Army National Guard and the U.S. Army Reserve were mobilized 

to active duty positions. In addition, other reservists are serving 

 6

 The number of reservists mobilized changes on a continuous basis as certain reservists 

are released and others are called-up, as mission needs change. 

Background 
Page 4 GAO-03-997T 

throughout the world in peacekeeping missions. The involvement of 

reservists in military operations of all sizes, from small humanitarian 

missions to major theater wars, will likely continue under the military’s 

current war-fighting strategy and its peacetime support operations. 

The Army has designated some Army National Guard and U.S. Army 

Reserve units and individuals as early-deploying reservists to ensure that 

forces are available to respond rapidly to an unexpected event or for any 

other need. Usually, those designated as early-deploying reservists would 

be the first troops mobilized if two major ground wars were underway 

concurrently. The units and individual reservists designated as earlydeploying reservists change as the missions or war plans change. The 

Army estimates that of its 560,000 reservists, approximately 90,000 are 

reservists who have been individually categorized as early-deploying 

reservists or are reservists who are assigned to Army National Guard and 

U.S. Army Reserve units that have been designated as early-deploying 

units. 

The Army must comply with the following six statutory requirements that 

are designed to help ensure the medical and dental readiness of its earlydeploying reservists. 

• All reservists including early-deployers are required to 

• have a 5-year physical examination,7 and 

• complete an annual certificate of physical condition.8

• All early-deploying reservists are also required to have 

• a biennial physical examination if over age 40,9

• an annual medical screening,10

• an annual dental screening,11 and 

• dental treatment.12

 7

10 U.S.C. §10206(a)(1)(2000). 

8

10 U.S.C. §10206(a)(2)(2000). 

9

10 U.S.C. §1074a(d)(1)(B)(2000). 

1010 U.S.C. §1074a(d)(1)(A)(2000). 

1110 U.S.C. §1074a(d)(1)(C)(2000). 

1210 U.S.C. §1074a(d)(1)(D)(2000). 
Page 5 GAO-03-997T 

Army regulations state that the 5- and 2-year physical examinations are 

designed to provide the information needed to identify health risks, 

suggest lifestyle modifications, and initiate treatment of illnesses. While 

the two examinations are similar, the biennial examination for earlydeploying reservists over age 4013 contains additional age-specific 

screenings such as a prostate examination, a prostate-specific antigen test, 

and a fasting lipid profile that includes testing for total cholesterol, lowdensity lipoproteins, and high-density lipoproteins. The Army pays for 

these examinations. 

The examinations are also used to assign early-deploying reservists a 

physical profile rating, ranging from P1 to P4, in six assessment areas: (a) 

Physical capacity, (b) Upper extremities, (c) Lower extremities, (d) 

Hearing-ears, (e) Vision-eyes, and (f) Psychiatric. (See app. I for the 

Army’s Physical Profile Rating Guide.) According to the Army, P1 

represents a non-duty-limiting condition, meaning that the individual is fit 

for duty and possesses no physical or psychiatric impairments. P2 means a 

condition may exist; however, it is not duty-limiting. P3 or P4 means that 

the individual has a duty-limiting condition in one of the six assessment 

areas. P4 means the individual functions below the P3 level. A rating of 

either P3 or P4 puts the reservist in a nondeployable status or may result 

in the changing of the reservist’s job classification. 

Army regulations that implement the statutory certification requirement 

provide that all reservists—including early-deploying reservists—certify 

their physical condition annually on a two-page certification form. Army 

early-deploying reservists must report doctor or dentist visits since their 

last examination, describe current medical or dental problems, and 

disclose any medications they are currently taking. In addition, the Army is 

required to conduct an annual medical screening for all early-deploying 

reservists. According to Army regulations, the Army is to meet the annual 

medical screening requirement by reviewing the medical certificate 

required of each early-deploying reservist. 

Further, Army early-deploying reservists are required to undergo, at the 

Army’s expense, an annual dental examination. The Army is also required 

to provide and pay for the dental treatment needed to bring an earlydeploying reservist’s dental status up to deployment standards—either 

dental class 1 or 2. Reservists in dental class 3 and 4 are not deployable. 

 13Approximately 22,500 early-deploying reservists are over age 40. 
Page 6 GAO-03-997T 

Class 3 reservists could have dental emergencies in the next 12 months, 

and reservists in class 4 have not had the required annual dental 

examination. 

The Army has not consistently carried out the requirements that earlydeploying reservists undergo 5- or 2-year physical examinations, and the 

required dental examination. In addition, the Army has not required earlydeploying reservists to complete the annual medical certificate of their 

health condition, which provides the basis for the required annual medical 

screening. Accordingly, the Army does not have sufficient health 

information on early-deploying reservists. Furthermore, the Army does 

not have the ability to maintain information from medical and dental 

records and annual medical certificates at the aggregate or individual 

level, and therefore does not know the overall health status of its earlydeploying reservists. 

We found that the Army has not consistently met the statutory 

requirements to provide early-deploying reservists physical examinations 

at 5- or 2-year intervals. At the seven Army early-deploying reserve units 

we visited, about 66 percent of the medical records were available for our 

review. 14 Based on our review of these records, 13 percent of the 

reservists did not have a current 5-year physical examination on file. 

Further, our review of the available records found that approximately 68 

percent of early-deploying reservists over age 40 did not have a record of a 

current biennial examination. 

Army early-deploying reservists are required by statute to complete an 

annual medical certificate of their health status, and regulations require 

the Army to review the form to satisfy the annual screening requirement. 

In performing our review of the records on hand, we found that none of 

the units we visited required that its reservists complete the annual 

medical certificate, and consequently, none of them were available for 

review. Furthermore, Army officials stated that reservists at most other 

units have not filled out the certification form and that enforcement of this 

requirement was poor. 

 14 There were 504 early-deploying reservists assigned to the seven units we visited. Medical 

records for 332 reservists were available for our review. Army administrators told us that 

the remaining files were in transit, with the reservist, or on file at another location. 

The Army Has Not 

Collected and 

Maintained All 

Required Medical and 

Dental Information on 

Early-Deploying 

Reservists 

Examinations Have Not 

Always Been Performed 

and Annual Medical 

Certificates Have Not Been 

Completed and Reviewed 
Page 7 GAO-03-997T 

The Army is also statutorily required to provide early-deploying reservists 

with an annual dental examination to establish whether reservists meet 

the dental standards for deployment. At the seven early-deploying units 

we visited, we found that about 49 percent of the reservists whose records 

were available for review did not have a record of a current dental 

examination. 

The Army’s two automated information systems for monitoring reservists’ 

health do not maintain important medical and dental information for earlydeploying reservists—including information on the early-deploying 

reservists’ overall health status, information from the annual medical 

certificate form, dental classifications, and the date of dental 

examinations. In one system, the Regional Level Application Software, the 

records provide information on the dates of the 5-year physical 

examination and the physical profile ratings. In the other system, the 

Medical Occupational Database System, the records provide information 

on HIV status, immunizations, and DNA specimens. Neither system allows 

the Army to review medical and dental information for entire units at an 

aggregate level. The Army is aware of the information shortcomings of 

these systems and acknowledges that having sufficient, accurate, and 

current information on the health status of reservists is critical for 

monitoring combat readiness. According to Army officials, in 2003 the 

Army plans to expand the Medical Occupational Database System to 

provide access to current, accurate, and relevant medical and dental 

information at the aggregate and individual level for all of its reservists—

including early-deploying reservists. According to Army officials, this 

information will be readily available to the U.S. Army Reserve Command. 

Once available, the Army can use this information to determine which 

early-deploying reservists meet the Army’s health care standards and are 

ready for deployment. 

Army’s Automated 

Systems Do Not Contain 

Comprehensive Health 

Information on EarlyDeploying Reservists 
Page 8 GAO-03-997T 

Medical experts recommend physical and dental examinations as an 

effective means of assessing health. For some people, the frequency and 

content of physical examinations vary according to the specific demands 

of their job. Because Army early-deploying reservists need to be healthy 

to fulfill their professional responsibilities, periodic examinations are 

useful for assessing whether they can perform their assigned duties. 

Furthermore, the estimated annual cost to conduct periodic 

examinations—about $140—is relatively modest compared to the 

thousands of dollars the Army spends for salaries and training of earlydeploying reservists—an investment that may be lost if reservists can not 

perform their assigned duties. Such information is also needed by VA to 

adjudicate disability claims and to provide health benefits. 

Physical and dental examinations are geared towards assessing and 

improving the overall health of the general population. The U.S. 

Preventive Services Task Force15 and many other medical organizations no 

longer recommend annual physical examinations for adults—preferring 

instead a more selective approach to detecting and preventing health 

problems. In 1996, the task force reported that while visits with primary 

care clinicians are important, performing the same interventions annually 

on all patients is not the most clinically effective approach to disease 

prevention.16 Consistent with its finding, the task force recommended that 

the frequency and content of periodic health examinations should be 

based on the unique health risks of individual patients. Today, many 

health associations and organizations are recommending periodic health 

examinations that incorporate age-specific screenings, such as cholesterol 

screenings for men (beginning at age 35) and women (beginning at age 45) 

every 5 years, and clinical breast examinations every 3 to 5 years for 

women between the ages of 19 and 39. Further, oral health care experts 

emphasize the importance of regular 6- to 12-month dental examinations. 

Both the private and public sectors have established a fixed schedule of 

physical examinations for certain occupations to help ensure that workers 

 15 The U.S. Preventive Services Task Force was established by the U.S. Public Health 

Service in 1984 as an independent panel of experts to review the effectiveness of clinical 

preventive services—screening tests for early detection of disease, immunizations to 

prevent infections, and counseling for risk reduction. 

16 Guide to Clinical Preventive Services, Second Edition—1996, Report of the U.S. 

Preventive Services Task Force, HHS Office of Public Health and Science, Office of Disease 

Prevention and Health Promotion. 

Periodic Physical and 

Dental Examinations 

Are Valuable for 

Assessing Health 

Status and Provide 

Beneficial 

Information to the 

Army and VA 

Experts Look to Screening 

and Examinations as Key 

Indicators of Health 
Page 9 GAO-03-997T 

are healthy enough to meet the specific demands of their jobs. For 

example, the Federal Aviation Administration requires commercial pilots 

to undergo a physical examination once every 6 months. U.S. National 

Park Service personnel who perform physically demanding duties have a 

physical examination once every other year for those under age 40, and on 

an annual basis for those over age 40. Additionally, guidelines published 

by the National Fire Protection Association recommend that firefighters 

have an annual physical examination regardless of age. 

In the case of Army early-deploying reservists, the goal of the physical and 

dental examinations is to help ensure that the reservists are fit enough to 

be deployed rapidly and perform their assigned jobs. Furthermore, the 

Army recognizes that some jobs are more demanding than others and 

require more frequent examinations. For example, the Army requires that 

aviators undergo a physical examination once a year, while marine divers 

and parachutists have physical examinations once every 3 years. 

While governing statutes and regulations require physical examinations at 

specific intervals, the Army has raised concerns about the appropriate 

frequency for them. In a 1999 report to the Congress, the Offices of the 

Assistant Secretaries of Defense for Health Affairs and Reserve Affairs 

stated that while there were no data to support the benefits of conducting 

periodic physical examinations, DOD was reluctant to recommend a 

change to the statutory requirements.17 The report stated that additional 

research needs to be undertaken to identify and develop a more costeffective, focused health assessment tool for use in conducting physical 

exams for reservists—in order to ensure the medical readiness of reserve 

forces. However, as of February 2003, DOD had not conducted this 

research. 

For its early-deploying reservists, the Army conducts and pays for physical 

and dental examinations and selected dental treatments at military 

treatment facilities or pays civilian physicians and dentists to provide 

these services. The Army could not provide us with information on the 

cost to provide these services at military hospitals or clinics primarily 

because it does not have a cost accounting system that records or 

 17 Report To Congress: Means of Improving the Provision of Uniform and Consistent 

Medical and Dental Care to Members of the Reserve Components (Washington, D.C.: 

October 1999). 

Cost of Conducting 

Physical and Dental 

Examinations and 

Providing Dental 

Treatments 
Page 10 GAO-03-997T 

generates cost data for each patient.18 However, the Army was able to 

provide us with information on the amount it pays civilian providers for 

these examinations under the Federal Strategic Health Care Alliance 

program (FEDS_HEAL )—an alliance of private physicians and dentists 

and other physicians and dentists who work for VA and HHS’s Division of 

Federal Occupational Health. FEDS_HEAL is a program that allows Army 

early-deploying reservists to obtain required physical and dental 

examinations and dental treatment from local providers. 

Using FEDS_HEAL contract cost information, we estimate the average 

cost of the examinations to be about $140 per early-deploying reservist per 

year. We developed the estimate over one 5- year period by calculating the 

annual cost for those early-deploying reservists requiring a physical 

examination once every 5 years, calculating the cost for those requiring a 

physical examination once every 2 years, and calculating the cost for those 

requiring an initial dental examination and subsequent yearly dental 

examinations.19 The FEDS_HEAL cost for each physical examination for 

those under 40 is about $291, and for those over 40 is about $370. The 

Army estimates that the cost of annual dental examinations under the 

program to be about $80 for new patients and $40 for returning patients. 

The Army estimates that it would cost from $400 to $900 per reservist to 

bring those who need treatment from dental class 3 to dental class 2. 

For the Army, there is likely value in conducting periodic examinations 

because the average cost to provide physical and dental examinations per 

early-deploying reservist—about $140 annually over a 5-year period—is 

relatively low compared to the potential benefits associated with such 

examinations. These examinations could help protect the Army’s 

investment in its early-deploying reservists by increasing the likelihood 

that more reservists will be deployable. This likelihood is increased when 

the Army uses examinations to identify early-deploying reservists who do 

not meet the Army’s health standards and are thus not fit for duty. The 

Army can then intervene by treating, reassigning, or dismissing these 

reservists with duty-limiting conditions—before their mobilization and 

before the Army needs to rely on the reservists’ skills or occupations. 

 18 U.S. General Accounting Office, Department of Defense: Implications of Financial 

Management Issues, GAO/T-AIMD/NSIAD-00-264 (Washington, D.C.: July 20, 2000). 

19 The average annual cost does not include allowances for inflation, dental treatment, or 

specialized laboratory fees such as those for pregnancy, phlebotomy, or tuberculosis. 

Benefits of Conducting 

Periodic Examinations For 

the Army 
Page 11 GAO-03-997T 

Furthermore, by identifying duty-limiting conditions or the risks for 

developing them, periodic examinations give early-deploying reservists the 

opportunity to seek medical care for their conditions—prior to 

mobilization. 

Periodic examinations may provide another benefit to the Army. If the 

Army does not know the health condition of its early-deploying reservists, 

and if it expects some of them to be unfit and incapable of performing 

their duties, the Army may be required to maintain a larger number of 

reservists than it would otherwise need in order to fulfill its military and 

humanitarian missions. While data are not available to estimate these 

benefits, the benefit associated with reducing the number of reservists the 

Army needs to maintain for any given objective could be large enough to 

more than offset the cost of the examinations and treatments. The 

proportion of reservists whom the Army maintains but who cannot be 

deployed because of their health may be significant. For instance, 

according to a 1998 U.S. Army Medical Command study, a “significant 

number” of Army reservists could not be deployed for medical reasons 

during mobilization for the Persian Gulf War (1990-1991).20 Further, 

according to a study by the Tri-Service Center for Oral Health Studies at 

the Uniformed Services University of the Health Sciences, an estimated 25 

percent of Army reservists who were mobilized in response to the events 

of September 11, 2001, were in dental class 3 and were thus 

undeployable.21 In fact, our analysis of the available current dental 

examinations at the seven early-deploying units showed a similar 

percentage of reservists—22 percent—who were in dental class 3.22 With 

each undeployable reservist, the Army loses, at least temporarily, a 

significant investment that is large compared to the cost of examining and 

treating these reservists. The annual salary for an Army early-deploying 

reservist in fiscal year 2001 ranged from $2,200 to $19,000. The Army 

spends additional amounts to train and equip each reservist and, in some 

cases, provides allowances for subsistence and housing. Additionally, for 

 20 The U.S. Army Medical Command’s: Reserve Component 746 Study, (June 22, 1998), 

provides no specific number stating only that a “significant number” could not be deployed. 

21 This study included reservists from the U.S. Army Reserve but not reservists from the 

Army National Guard. 

22 Twenty-two dental examinations listed early-deploying reservists in class 3 out of 101 

current (within 1 year) dental examinations. Additional examinations that were available 

for our review were either out of date or conducted by nondental personnel. 
Page 12 GAO-03-997T 

each reservist it mobilizes, the Army spends about $800.23 If it does not 

examine all of its early-deploying reservists, the Army risks losing its 

investment because it will train, support, and mobilize reservists who 

might not be deployed because of their health. 

Both VBA and VHA need health assessment data obtained by the Army to 

adjudicate disability claims and provide medial care. In general, a reservist 

who is disabled while on active duty, or on inactive duty for training, is 

eligible for service-connected disability compensation, and can file a claim 

at one of VBA’s 57 regional offices. To provide such disability 

compensation, VBA needs to determine that each claimed disability exists, 

and that each was caused or aggravated by the veteran’s military service. 

The evidence needed to prove service connection includes records of 

service to identify when the veteran served and records of medical 

treatment provided while the veteran was in military service. More timely 

and accurate health information collection by the Army and the other 

military services can help VBA provide disabled reservists with more 

timely and accurate decisions on their claims for disability compensation.24

Complete and accurate health data can also help VHA provide medical 

care to reservists who become eligible for veterans benefits. 

Army reservists have been increasingly called upon to serve in a variety of 

operations, including peacekeeping missions and the current war on 

terrorism. Given this responsibility, periodic health examinations are 

important to help ensure that Army early-deploying reservists are fit for 

deployment and can be deployed rapidly to meet humanitarian and 

wartime needs. However, the Army has not fully complied with statutory 

requirements to assess and monitor the medical and dental status of earlydeploying reservists. Consequently, the Army does not know how many of 

them can perform their assigned duties and are ready for deployment. 

 23 U.S. General Accounting Office, Reserve Forces: Cost, Funding, and Use of Army 

Reserve Components in Peacekeeping Operations, GAO/NSAID-98-190R (Washington, 

D.C.: May 15, 1998). 

24See U.S. General Accounting Office, Veterans’ Benefits: Despite Recent Improvements, 

Meeting Claims Processing Goals Will Be Challenging, GAO-02-645T (Washington, D.C.: 

April 26, 2002) for a discussion of the information needed to adjudicate a disability claim. 

Benefits of Health 

Assessments for VA 

Concluding 

Observations 
Page 13 GAO-03-997T 

The Army will realize benefits by fully complying with the statutory 

requirements. The information gained from periodic physical and dental 

examinations, coupled with age-specific screenings and information 

provided by early-deploying reservists on an annual basis in their medical 

certificates, will assist the Army in identifying potential duty-limiting 

medical and dental problems within its reserve forces. This information 

will help ensure that early-deploying reservists are ready for their 

deployment duties. Given the importance of maintaining a ready force, the 

benefits associated with the relatively low annual cost of about $140 per 

reservist to conduct these examinations outweighs the thousands of 

dollars spent in salary and training costs that are lost when an earlydeploying reservist is not fit for duty. 

The Army’s planned expansion, in 2003, of an automated health care 

information system is critical for capturing the key medical and dental 

information needed to monitor the health status of early-deploying 

reservists. Once collected, the Army will have additional information to 

conduct the research suggested by DOD’s Offices of Health Affairs and 

Reserve Affairs to determine the most effective approach, which could 

include the frequency of physical examinations, for determining whether 

early-deploying reservists are healthy, can perform their assigned duties, 

and can be rapidly deployed. 

While our work focused on the Army’s efforts to assess the health status of 

its early-deploying reservists, it also has implications for veterans. 

Implementing our recommendations that DOD comply with the statutory 

requirements, which DOD has agreed to, will also be of benefit to VA. VA’s 

ability to perform its missions to provide medical care to veterans and 

compensate them for their service-connected disabilities could be 

hampered if the Army’s medical surveillance system contains inadequate 

or incomplete information. 

Mr. Chairman, this concludes my prepared statement. I will be happy to 

answer any questions you or other members of the subcommittee may 

have. 

For further information regarding this testimony, please contact Marjorie 

E. Kanof at (202) 512-7101. Michael T. Blair, Jr., Aditi S. Archer, Richard J. 

Wade, and Gregory D. Whitney also contributed to this statement. 

Contact and 

Acknowledgments 
Page 14 GAO-03-997T 

 Assessment areas 

Physical profile 

rating 

Physical 

capacity 

Upper 

extremities 

Lower 

extremities Hearing-ears Vision-eyes Psychiatric 

 Organic defects, 

strength, 

stamina, agility, 

energy, muscular 

coordination, 

function, and 

similar factors. 

Strength, range 

of motion, and 

general efficiency 

of upper arm, 

shoulder girdle, 

and upper back, 

including cervical 

and thoracic 

vertebrae. 

Strength, range 

of movement, 

and efficiency of 

feet, legs, lower 

back, and pelvic 

girdle. 

Auditory 

sensitivity and 

organic disease 

of the ears. 

Visual acuity and 

organic disease 

of the eyes and 

lids. 

Type, severity, 

and duration of 

the psychiatric 

symptoms or 

disorder 

existing at the 

time the profile 

is determined. 

Amount of 

external 

precipitating 

stress. 

Predispositions 

as determined 

by the basic 

personality 

makeup, 

intelligence, 

performance, 

and history of 

past psychiatric 

disorder 

impairment of 

functional 

capacity. 

P1 

(Non-duty-limiting 

conditions) 

Good muscular 

development with 

ability to perform 

maximum effort 

for indefinite 

periods. 

No loss of digits 

or limitation of 

motion; no 

demonstrable 

abnormality; able 

to do hand-tohand fighting. 

No loss of digits 

or limitation of 

motion; no 

demonstrable 

abnormality; able 

to perform long 

marches, stand 

over long 

periods, and run. 

Audiometer 

average level for 

each ear not 

more than 25 dBa

at 500, 1000, or 

2000 Hzb

 with no 

individual level 

greater than 30 

dB. Not over 45 

dB at 4000 Hz. 

Uncorrected 

vision acuity 

20/200 

correctable to 

20/20 in each 

eye. 

No psychiatric 

pathology; may 

have history of 

transient 

personality 

disorder. 

Appendix I: Army Physical Profile Rating 

Guide 
Page 15 GAO-03-997T 

 Assessment areas 

Physical profile 

rating 

Physical 

capacity 

Upper 

extremities 

Lower 

extremities Hearing-ears Vision-eyes Psychiatric 

P2 

(Non-duty-limiting 

conditions) 

Able to perform 

maximum effort 

over long 

periods. 

Slightly limited 

mobility of joints, 

muscular 

weakness, or 

other musculoskeletal defects 

that do not 

prevent hand-tohand fighting and 

do not disqualify 

for prolonged 

effort. 

Slightly limited 

mobility of joints, 

muscular 

weakness, or 

other musculoskeletal defects 

that do not 

prevent moderate 

marching, 

climbing, timed 

walking, or 

prolonged effort. 

Audiometer 

average level for 

each ear at 500, 

1000, or 2000 

Hz, not more 

than 30 dB, with 

no individual 

level greater than 

35 dB at these 

frequencies, and 

level not more 

than 55 dB at 

4000 Hz; or 

audiometer level 

30 dB at 500 Hz, 

25 dB at 1000 

and 2000 Hz, 

and 35 dB at 

4000 Hz in better 

ear. (Poorer ear 

may be deaf.) 

Distant visual 

acuity correctable 

to not worse than 

20/40 and 20/70, 

or 20/30 and 

20/100, or 20/20 

and 20/400. 

May have 

history of 

recovery from 

an acute 

psychotic 

reaction due to 

external or 

toxic causes 

unrelated to 

alcohol or drug 

addiction. 

P3 

(Duty-limiting 

conditions) 

Unable to 

perform full effort 

except for brief or 

moderate 

periods. 

Defects or 

impairments that 

require significant 

restriction of use. 

Defects or 

impairments that 

require significant 

restriction of use. 

Speech reception 

threshold in best 

ear not greater 

than 30 dB HLc

measured with or 

without hearing 

aid, or chronic 

ear disease. 

Uncorrected 

distant visual 

acuity of any 

degree that is 

correctable to not 

less than 20/40 in 

the better eye. 

Satisfactory 

remission from 

an acute 

psychotic or 

neurotic 

episode that 

permits 

utilization 

under specific 

conditions 

(assignment 

when 

outpatient 

psychiatric 

treatment is 

available or 

certain duties 

can be 

avoided). 

P4 

(Duty-limiting 

conditions) 

Functional level 

below P3. 

Functional level 

below P3. 

Functional level 

below P3. 

Functional level 

below P3. 

Functional level 

below P3. 

Functional 

level below P3. 

Source: Department of the Army. 

Note: Army Regulation 40-501, Mar. 28, 2002. 

a

dB (decibels), the decibel is a measure of the intensity of sound. 

b

Hz (Hertz), the Hertz is the measure of sound frequency or pitch. 

c

HL (hearing loss). 
Page 16 GAO-03-997T 

Defense Health Care: Army Needs to Assess the Health Status of All 

Early-Deploying Reservists. GAO-03-347. Washington, D.C.: April 15, 2003. 

Military Personnel: Preliminary Observations Related to Income, 

Benefits, and Employer Support for Reservists During Mobilizations. 

GAO-03-549T. Washington, D.C.: March 19, 2003. 

Defense Health Care: Most Reservists Have Civilian Health Coverage but 

More Assistance Is Needed When TRICARE Is Used. GAO-02-829. 

Washington, D.C.: September 6, 2002. 

Reserve Forces: DOD Actions Needed to Better Manage Relations between 

Reservists and Their Employers. GAO-02-608. Washington, D.C.: 

June 13, 2002. 

Veterans’ Benefits: Despite Recent Improvements, Meeting Claims 

Processing Goals Will Be Challenging. GAO-02-645T. Washington, D.C.: 

April 26, 2002. 

VA and Defense Health Care: Military Medical Surveillance Policies in 

Place, But Implementation Challenges Remain. GAO-02-478T. 

Washington, D.C.: February 27, 2002. 

Reserve Forces: Cost, Funding, and Use of Army Reserve Components in 

Peacekeeping Operations. GAO/NSAID-98-190R. Washington, D.C.: 

May 15, 1998. 

Defense Health Program: Future Costs Are Likely to Be Greater than 

Estimated. GAO/NSIAD-97-83BR. Washington, D.C.: February 21, 1997. 

Wartime Medical Care: DOD Is Addressing Capability Shortfalls, but 

Challenges Remain. GAO/NSIAD-96-224. Washington, D.C.: 

September 25, 1996. 

Reserve Forces: DOD Policies Do Not Ensure That Personnel Meet 

Medical and Physical Fitness Standards. GAO/NSIAD-94-36. Washington, 

D.C.: March 23, 1994. 

Operation Desert Storm: Problems With Air Force Medical Readiness. 

GAO-03-549T. Washington, D.C.: December 30, 1993. 

Defense Health Care: Physical Exams and Dental Care Following the 

Persian Gulf War. GAO/HRD-93-5. Washington, D.C.: October 15, 1992. 

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